Ultrasound Case 023


An 11 year old boy is hit with a cricket ball mid sternum and is very tender. Your resident does an ultrasound and is concerned they can see a fracture.

Describe and interpret these scans

Image 1: Longitudinal transducer position mid anterior chest. Initially at the sternal notch it is slid caudally to the cartilaginous sterno-manubrial angle then on down the midline of the sterum.

The sternum has several ossification centres. The cartilaginous junctions between the sternebrae are seen as hypoechoic lines across the sternum.

The 2nd rib comes off at the sternomabubrial junction, the 3rd at the junction between the first and second sternebae, and so on.

These are not fractures.


Normal paediatric sternum.

At each of the hypoechoic cartilaginous junctions between the sternebrae there is a gentle ridge. Again this should not be interpreted as a buckle type fracture. These ridges persist variably into adulthood.



An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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